We propose a four-year project to develop, pilot, and evaluate an intervention to change ventilator management in patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) cared for in community intensive care units (ICUs). ALI/ARDS is a pulmonary complication of critical illness associated with an estimated 25,000 deaths per year in the United States. Appropriate ventilator management of this syndrome can reduce mortality by 22 percent. Unfortunately, data indicate that patients with ALI/ARDS are not identified, that appropriate ventilator management is not being used, and that there are significant barriers to its implementation. The specific aims of this project are: (1) To develop and pilot an intervention to increase the use of lung protective ventilation in patients with ALI/ARDS and (2) To evaluate the effectiveness of the intervention at increasing the use of lung protective ventilation. We will develop and pilot a multifaceted intervention consisting of (1) physician, nurse, and respiratory therapist education, (2) physician prompting on the diagnosis of ALI/ARDS and the use of lung protective ventilation, (3) a protocol to guide ventilator management, and (4) feedback on clinical performance. We will evaluate the intervention's effectiveness in a multi-center randomized controlled trial in 10 community hospitals. The primary outcome of this study will be change in use of lung protective ventilation; secondarily, we will evaluate its effect on mortality and duration of mechanical ventilation. Lung protective ventilation has the potential to save thousands of lives each year in the United States if techniques can be developed to implement this treatment in the community. The overall objective of the proposed project is to develop, pilot, and evaluate an intervention that can be implemented in any ICU that will increase the use of a lung protective ventilation protocol proven to reduce mortality in ALI/ARDS.